Alimta too pricey for NICE in maintenance setting

NICE is not recommending Lilly’s lung cancer drug Alimta in a maintenance setting over cost concerns.

Specifically, the watchdog says in draft guidance that it is not backing Alimta (pemetrexed) for the maintenance treatment of non-small-cell lung cancer (NSCLC) following induction therapy with Alimta and cisplatin.

NICE has already recommended pemetrexed as a first line-treatment option for NSCLC and as a maintenance treatment option following platinum-based chemotherapy in combination with Lilly’s Gemzar (gemcitabine), paclitaxel or docetaxel.

This appraisal is concerned with the extension to the marketing authorisation for pemetrexed as a maintenance treatment following pemetrexed and cisplatin.

Commenting on the draft guidance, Sir Andrew Dillon, chief executive of NICE said: “Pemetrexed is already recommended as maintenance treatment following a different first line treatment. However in this case, as maintenance treatment following pemetrexed and cisplatin, although effective, the potential gain for patients are less but the cost to the NHS remains the same.

“It is disappointing not to be able to recommend pemetrexed in our preliminary guidance, but we can only recommend treatments which are both clinically and cost effective.”

The results from the PARAMOUNT clinical trial, which Lilly submitted to NICE, indicate that its drug provides a gain in progression-free survival of 1.28 months, and an overall survival of 2.85 months.

But even with this, NICE’s committee considered that Alimta was in excess of £76,300 per Quality Adjusted Life Year (QALY) gained, much higher than the £30,000 QALY limit that NICE usually adheres to. The average total treatment cost per patient is £11,640, according to the watchdog.

Lung cancer is one of the most common cancers in the UK, with around 38,000 people diagnosed every year. NSCLC is the most common type of lung cancer, accounting for around 80% of all cases.

The two main goals of maintenance treatment are to prolong the period of remission after first-line chemotherapy and increase the likelihood of being able to receive second-line chemotherapy.